It was the ninth hour of a 12-hour night on Labor & Delivery when my fourth patient presented with complaints of vaginal bleeding. Exhausted, I told myself this had to be another worst-case scenario—probably placenta previa or abruption.
I initially performed a comprehensive review of symptoms and thorough patient history, which I presented to the resident. He was a cocky first-year resident, just starting his first clinical rotation. After I presented, he ordered me to perform a manual exam to see if the patient had dilated her cervix.
I was trained never to check a patient who presented with vaginal bleeding. So I questioned the order. Tactfully, but perhaps too timidly, I asked, “Are you sure?”
“Why are you questioning me? You are just a nurse. You didn’t go through medical school.”
I froze. Maybe he is right, I thought. I’m not competent. I am merely a nurse. Weeks later, the negative self-talk continued and I second-guessed my assessment of patients and ability to provide the best possible patient care.
Many new nurses can be stunned into silence by an intimidating physician. With practice, though, you don’t have to—nor should you—stay silent. When I know the doc is wrong, and I’m right, I try to follow these steps:
• I take a few moments to collect my thoughts and emotions before engaging in further discussion;
• I always try to remain professional, no matter how uncomfortable the situation;
• I ask the physician if he/she would take a few minutes to discuss the situation in more detail—outside of the patient’s room;
• I explain to the physician that nurses, as a patient’s advocate, are obligated to act in the best interest of the patient. I supply evidence to back my stance;
• If my authority is still questioned, I ask the physician to supply evidence-based guidelines upon which his/her order is based;
• If there is an impasse, I research the hospital’s policy; and
• When necessary, I utilize senior nursing staff to support my actions.
I wish I could say a doctor has never demeaned me since, but it occasionally still happens. The difference is I don’t let my confidence take a dive. I work out the issue—and so can you.
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October 15th, 2007 at 6:18 am
If you are right, you are right.
If the junior doc, thinks otherwise you can always refuse to do it as “not in the patients best interest”.
At best the doctor will go crying to his seniors who will probably back what you’ve said. Lesson soon learnt!
Max
November 29th, 2007 at 5:57 pm
grad-itis, demi-gods… to bad the doc forgot he is human and is capable of making mistakes…
December 22nd, 2007 at 7:35 am
He’ll learn his lesson the hard way. Fortunately not too many new grads are like that, in fact most doc’s are terrified, but what goes around comes around.
I get around bad direction by a doctor by asking a question that will make him think he has come up with the idea himself.
eg I say things like “What do you think about.. or Have you tried…”
July 22nd, 2008 at 3:04 pm
I think this nurse is rude and lyier. As a nurse dealing with residents, they are very nice and want our approval, they only become stubern when the nurse is rude and cocky as the one above.
July 24th, 2008 at 11:48 am
that’s too bad, tina. i think that as nurses we often put blame or fault other nurse’s too quickly, only to harm our image. And what you said is not true. We recently moved our whole hospital to a new location and afterwards were extremely busy for 6 straight months, which meant people were very tired and under a lot of pressure-and unfortunately these feelings were taken out on nurses-not because the nurse was rude or cocky to the interns/residents but because the doctors didn’t always want to deal with non-life threatening issues like tylenol for a headache.
July 28th, 2008 at 10:00 am
Tina,
Your argument is as well formed as your grammar. However, to pull the crucial element from your post; there is definitely a need to maintain a mutual respect.
Unfortunately, as nurses, it is often the case that medic-nurse interactions take the form of parent-child rather than adult-adult interaction. I have very rarely seen a nurse take the dominant stance against a doctor. That usually only (successfully) occurs when the nurse is experienced enough to know they are right and refuses to compromise their standard. This is not being rude – this is being a professional.
November 5th, 2008 at 9:08 pm
Wow, Tina YOU are rude! How can you say that? It is okay for her (Brittany Heck) to question something that seems different. As a nurse your job is to be the patient’s advocate. Your job is always on the line when you work and if she believed something should not have been done then she can speak up but as a professional! As you can see she has done that! You are a disgrace to nurses Tina. I will pray for you and the patients you take care of!
November 5th, 2008 at 9:09 pm
wow.. she can’t even spell!!!! English 101 buddy!
November 5th, 2008 at 11:00 pm
Always listen to that inner voice that says “hmmm..something is not right here” in other words, follow your gut. It will not fail you! And as for that fool speaking to you in that manner- UNACCEPTABLE!! This passivity to these MDs is part of the reason why we cannot advance as a profession. We are professionally and ethically bound to question any and every order and or directive that may not be in the best interest of the patient. Period. If the public actually knew who saved the majority of the lives in this country (along with a lot of MD’s rear ends) the general public would be shocked into silence!!
August 21st, 2009 at 8:59 am
I agree with Mr Ian regarding Tina.
As a paediatric student I challenged a senior member of the team regarding a drug dosage on a child, it turned out that i was correct and he thanked me for challenging him!! As a student I am still bound by the NMC rules which state that a nurse must act without delay, if someone may be putting a patient or colleague at risk.
August 21st, 2009 at 5:26 pm
I work as an ortho RN … and let me tell you, the 1st year residents have no clue what is going on, although some our better than others. I found myself having to tell the resident that a patient with a tachy HR of 160 – 180 needs lopressor IV and yes if an h/h is low we DO need to order blood and I saw this same resident writing down EVERYTHING i was saying that was a norm on our unit … I have also reported to 2 senior residents that my patient was a having a stroke and they said NO she’s not. the pt was able to move her hands at the beginning of my shift and as the night progressed she wouldn’t even hold a glass of water – grasps were weak she had numbness and tingling to the L arm and speech was slurred and could not make a complete sentence AND they chalked it up to narcs…??? and LEFT! So i called all the drs i could that were consulted for the pt and Neuro resident was supposed to come see her in 20min.. he/she never showed the medical resident blew me off. so i called a condition C to activate the stroke team after and 1hr and ahalf of calling and trying to get MDs to see her i just gave up and called a condition- she was transferred to the ICU and she did actually have a stroke. and about 2 days later her Neuro attending came to find me and THANKED me for knowing how to identify a stroke and not letting the senior residents bully me into thinking i do NOT know how to adequately assess for a stroke. he said to never lose that it made a difference for this pt
so you see you DO know what your patients needs especially when you work with that patient population on a daily basis. And i dare a doctor to talk to me that way… that’s completely unacceptable.
I always feel that we, the nurses, are with the patients the most. we see them all day and we can tell before they can if they are getting better or worse. we have been trained and i believe we also went to school and graduated and some of us have MSN in nursing. So we too have a good education for our job. sometimes they forget that.
and really do they know what we can do or not allowed to do? sometimes they need a gentle reminder that do not know everything just because they graduated from med school.